Lesson from history
- 31 October 2007
Those with long-ish healthcare IT memories will recall the day Sir John Pattison from the Department of Health visited Healthcare Computing 2002 in Harrogate to announce what came to be known as the National Programme for IT.
Sir John, then the DH’s director of research, analysis and information, described the conversation at the now-famous Downing Street seminar about time scales. The DH team was asked how long it would take to put in place the four elements of new infrastructure, electronic records, booked admissions and e-prescribing.
As E-Health Insider reported at the time, Sir John told a hushed audience: “We swallowed hard and said ‘three years’.” A tighter time scale was demanded and Sir John said that, in the end, they agreed on two years and nine months.
What we didn’t know was that Sir John and his team had been given just 10 minutes to put the case! Wiring the NHS, a documentary broadcast last week on BBC Radio 4 included an interview in which Sir John revealed the brevity of his timeslot with Prime Minister Tony Blair at the height of the sofa government era.
Another revelation followed: it emerged that the three year time frame and £2.4 billion budget attached to was meant all along to be the just the appetiser for a greater feast.
“I suggested it would take three years,” said Sir John, but added: “We did not get across that the initial timeframe of three years and budget of £2.4 billion was just the first phase and this is possibly where the concern for delayed implementation has come from.”
One of the many people the message plainly didn’t reach was GP, Dr Paul Cundy, chair of BMA’s IT committee who told the Radio 4 programme that the timescales were ‘ludicrously tight.’
“If you’d asked anyone with any sort of feet on the ground, anywhere near any sort of IT project, they would have said it was not possible,” said Dr Cundy.
Only BT among the national programme’s main contractors agreed to take part in the documentary. BT Health managing director, Patrick O’Connell, had a more philosophical take on the national programme’s delays.
"I think the whole thing got off to a slow start because most major programmes do," said O’Connell.
"There is a certain amount of coming together of ideas with practicalities. Some capabilities turn out to be less important.
"Some capabilities turn out to be more important and get brought forward in time. And some things people decide they really want to have like PACS, the picture archiving system that puts everything online – that wasn’t there on day one – but it came in later.
"We will probably finish not quite the same system that people thought they were going to buy on day one but a much richer, much fuller system and probably much more relevant."
The programme wheeled out many of the protagonists whose contributions to the debate over the years have made this area so interesting to cover.
Professor Martyn Thomas, leader of the NHS 23 computer sciences academics, who in 2006 called a technical review of the project, made an appearance.
“We believed an independent technical review of the programme – if it was constructive – could minimise the risks and help them move more quickly to a successful outcome,” he said.
There was a rueful footnote, however. “My feeling was that Richard Granger [director-general of NHS IT] and his team were generally open to having independent people help them, but it appears the Department of Health felt a review would be very damaging.”
Computer Weekly’s Tony Collins popped up to relive the saga of the National Audit Office’s mysterious ‘gushing’ report on the national programme.
Connecting for Health GP clinical lead, Professor Mike Pringle, used his smoothest bedside manner to explain why the Summary Care Record was needed. Patient lead, Marlene Winfield, meanwhile, recounted the evolution of the Care Record Guarantee.
There was a ghost at the feast, however. Director-general, Richard Granger, now ‘transitioning’ away from his role – though still appearing at international conferences – was ‘not allowed’ to appear and we had to make do with a few old snippets from past interviews.
Last word went to Sir John, now retired, who said: "The only question of any relevance is to look at the cost and benefit and say whether it is worth it. To my mind there will actually be no question about that. I cannot imagine a national health care system in the future that isn’t well and properly enabled by IT."
And of course, nobody can imagine such a future. But the debate is not – and has never been – about ‘well and properly enabling’ the NHS with 21st century IT; it is about how that happens. Sir John’s revelations about 10 minute presentations in Downing Street will do nothing to reassure those who think some expensive mistakes have been made.
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Linda Davidson
